I had a patient today scheduled for an EGD under MAC this morning, but he drank a full stomach's worth of breast milk 4 hours beforehand, he claimed it was ok per the NPO guidelines. Is this true?
NPO guidelines for breast milk??
- Thread starter Mikkel
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We have 3h.
How do you have a patient that drinks breast milk but knows npo guidlines 🤔
How do you have a patient that drinks breast milk but knows npo guidlines 🤔
D
deleted162650
Yes 4hrs for breastmilk is the guideline. I woulda cancelled just ‘cuz the guy was too weird though. I don’t think the guidelines were meant to apply to adults.
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An adult drinking breast milk would get 8 hours and a psych consult while he was waiting.
I would tell them that’s an accommodation we make for infants who can’t tolerate hunger pain and/or hypoglycemia, not for adults.
I would tell them that’s an accommodation we make for infants who can’t tolerate hunger pain and/or hypoglycemia, not for adults.
D
deleted162650
I think we may have stumbled upon the etiology of his stomach issues.
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Wait....did he drink from the bottle or "from the source" because maybe he doesn't really need that psych consult? Just sayin....
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Did he get it on Craigslist?
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Was it 100% Cambodian?
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WTF?
i think someone is messing with us.
i think someone is messing with us.
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Milk coagulates in the stomach on contact with stomach acid, so it’s really a solid...
Human Breast Milk Isn't Safe for Adults to Drink
While a black market for human breast milk is booming, it isn't safe for grown-ups to drink.
www.newsweek.com
Including breast milk?
Do babies process breast milk differently than adults? I always thought breast milk in baby stomach's "pass through" much more quickly compared to formula. Different water content?
I still had the patient wait 2 more hours before procedure. Patient had hiatal hernia and reflux esophagitis.
I didn't ask how he took the milk, but there wasn't anyone with him for me to guess.
D
deleted697535
That guy doesn't need an anaesthetic. He's an effing animal
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I’m obviously not anesthesia, but when we do nuclear medicine gastric emptying studies for motility disorders, radiotracer in breast milk behaves like a solid, rather than a liquid meal.Human Breast Milk Isn't Safe for Adults to Drink
While a black market for human breast milk is booming, it isn't safe for grown-ups to drink.
Including breast milk?
Do babies process breast milk differently than adults? I always thought breast milk in baby stomach's "pass through" much more quickly compared to formula. Different water content?
I still had the patient wait 2 more hours before procedure. Patient had hiatal hernia and reflux esophagitis.
I didn't ask how he took the milk, but there wasn't anyone with him for me to guess.
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I’ve heard that some weightlifters buy and use breast milk.
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Is anyone using point of care ultrasound to assess gastric content in patients with questionable NPO status and/or possible delayed gastric emptying?
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Ive read about it. Intriguing but I dont think it has been validated enough to use as a decision making tool at this time
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Home
Gastricultrasound.org is a free web-based educational resource that contains information related to the performance and interpretation of point-of-care perioperative gastric ultrasound for aspiration risk assessment. The information provided is based on peer-reviewed data and the opinion of the...
www.gastricultrasound.org
I had one attending who is all about it and I know it has led him to delay nonemergent cases before
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Would he be willing to do non-emergent cases that had eaten but didn't have anything on US?
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That, I'm not sure about.
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That doesn’t sound wise. If anything were to happen to the patient I would think he would be putting himself at undo medico-legal risk if he didn’t abide by the NPO guidelines for an elective case.
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I think it would be a nice move forward if we could have guidlines that would state that it's acceptable to proceed with GA if the stomach is proven empty on US.
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Well that's the entire problem with ultrasound (coming from a big believer), you discover things you wouldn't have otherwise discovered. What's the PPV of gastric ultrasonography? If you find something that otherwise wouldn't have made a difference, how valuable is it?
This is a great talk on that topic:
SonoBYTE: Mitral Valve Magic by James Rippey | SMACC Sydney
The appearance of high quality hand held ultrasound machines mean we will all have imaging available at our finger tips. This talk details a personal study on the impact this can have on families. It also outlines the frequency of incidental findings and raises questions regarding the...
smacc.net.au
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What about the flip side? Would you cancel a case that was NPO appropriate if you found food in the stomach? Do you put the ultrasound on the "NPO appropriate" patient who ate a full plate of spaghetti and garlic bread at 2359? What about the semi-elective trauma patient who was NPO appropriate that you were planning an LMA on for the X debridement?
I don't know what the data is, exactly, but I suspect most people's aspiration stories are people who are, or claim to be, NPO appropriate.
I don't know what the data is, exactly, but I suspect most people's aspiration stories are people who are, or claim to be, NPO appropriate.
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If it were me I would treat it like any other anesthetic we perform and risk stratify the patient based on what I feel his/her aspiration risk may be. If I took the patient's proper NPO status at face value but found food in their stomach on ultrasound, I would probably just plan for an RSI. The same would go for the trauma patient and I would abort my LMA plan and go straight to an ETT. I'm not sure we should routinely put an ultrasound on a patient who finished a full meal at midnight unless we were concerned about the patient's gastric emptying; e.g. gastroparesis, CP, on a bunch of narcotics, etc.
D
deleted875186
Can you give us a brief story of the types of cases he cancelled? I’m hoping it’s something like a patient who has multiple risks factors for a full stomach??
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Never happened in my presence, but was just something he talked about. The main sort of situation I think of was the questionable NPO status (yeah I haven't eaten anything since last night, but those crumbs on my shirt the nurse is talking about was from then).
When in doubt, tube.
